Mr. U.B is a 28-year-old male computer scientist with no previous medical history or any known keratoconus in the family. He complained of a progressive decrease in visual acuity in both eyes. The patient is right-handed and sleeps on the right side with his head lying on the right hand.
His refraction at the first visit (01/10th/2014) was : Right Eye (RE) 20/20 with +0.75 (-4.25 x 70 °) and Left Eye (LE) 20/20 with -1 (-3.25 x 125 °).
Clinical examination with the slit lamp suggested bilateral corneal thinning more pronounced in the left eye . We also found bilateral Vogt’s striae and Fleischer rings (Fleischer rings are pigmented rings in the peripheral cornea, resulting from iron deposition in basal epithelial cells, in the form of hemosiderin) in both eyes. The tear film Break Up Time (BUT) was also pathological (< 8 seconds) in both eyes, which reflected chronic ocular dryness.
Corneal topography revealed the presence of bilateral keratoconus, more pronounced in the left eye.
At his first visit, when asked about the possibility of frequent eye rubbing, the patient admitted to rubbing fairly frequently when working in front of the computer screen. He worked mostly at night and his eyes felt permanently dry. Rubbing his eyes gave him a sense of relief.
We explained to the patient that since vigorous eye rubbing had preceded the drop in visual acuity, this habit may have caused his cornea to deform, resulting in the keratoconic changes observed in his case.
We strongly advised this patient to stop rubbing his eyes, and treated the dry eye problem with intensive lubrication in the form of gels and artificial tears.
Here are pictures of the patient rubbing his eyes and his profiles
This case constitutes another evidence for eye rubbing being the root cause of keratoconus. Keratoconus is not a primitive dystrophy, but is instead a mechanical disease. Without eye rubbing , without repeated mechanical stress, there is no deformation of the corneal dome, and thus no keratoconus.
The cessation of eye rubbing resulted in the stabilization of the corneal deformation in this case. The difference maps performed over time demonstrate the absence of progression of the keratoconus. Some of these maps even suggest a possible improvement in the shape of the cornea, despite no other therapy but the cessation of eye rubbing being performed. Although the changes are likely to be artifactual, the topographic improvement could possibly be attributed to epithelial smoothing, as the cessation of eye rubbing promotes a more stable ocular surface.